Aging sucks. In particular, it sucks that aging creeps up on you your whole life, you feel fine, relatively healthy, nothing’s worrying you. You’re just going about your life as if nothing was ever going to change.

Until it does. In mortifying ways.

This is that story.

*****

I have been living with an embarrassing secret. Well, maybe not so secret to many of the people around me who have heard me calculate how far I have to go before I find a bathroom and deciding whether I can have a caffeinated beverage before I leave.

I have an overactive bladder. It’s a common condition. According to an interview with Dr. Kirtly Parker Jones posted on the University of Utah website, “Thirty percent of women ages 40-50 have an overactive bladder.” So, basically, I’m not special.

The weird thing is, you can have this condition but it just creeps up on you over the years until you suddenly realize, you are peeing all the time. A lot of times, I’m peeing preemptively. I’ve gone to the bathroom recently, but am about to the leave the house–maybe take a walk with the kid–so I make a calculated decision to go again to be safe. And it seems like the right thing to do…the smart thing to do. You figure, this is normal. It’s just what happens when you get older. While that may be true, my inexact approach to dealing with increasing bladder issues was kind of back-assward, as it turns out.

I mentioned to my V.A. doctor the bladder urgency, the waking in the nighttime, that while I’m on a medication called Solifenacin that helps a bit, I’m just not getting good sleep.

VA Doc: “I’ll refer you to physical therapy appointment for bladder training. (My word for it. I think they called it something professional like Pelvic Floor Exercises. Which, now that I think of it, sounds like a weird event at the Olympics.)

Me: “I…I’m going to go through potty training again?”

VA Doc: “It’s more like retraining, if that helps.”

Me: “Yeah. No.” I swear this is the universe getting revenge on the Potty Training on the Spectrum article I wrote about my son’s issues.

I meet a nice young lady who gets the most embarrassing part over with first: the pelvic exam. It’s a necessary step to make sure that there isn’t a physical cause to my problem. There is, but again, it is a very common one.

“You have prolapse.” She declares after letting me sit back up.

“Yeah, I know.” I say. But honestly, I’ve never asked whether there’s anything I can do about it. So I do now.

She gives me a brief explanation.

“Basically, the muscles that support the reproductive organs are weak to the point they no longer supports the uterus and it slips out of place.”

She goes on to explain how this contributes to incontinence. There is a somewhat complicated explanation of the bladder as an expanding balloon that has muscles surrounding it and below it. That the balloon learns to work in a certain way based on how frequently I take it to the bathroom and how much strength the muscles supporting it have.

“So how do we fix this?” I ask. “I’m already using a taco to keep things up in place.”

[Sidebar: the folded taco was the first effort to try and keep the uterus from making a break for the border. It’s technically called a pessary and it actually looks a lot more like a donut or a sombrero. But, you fold it like a taco to insert it. Hence my cool nickname for it.]

“We are going to work on some exercises to improve your bladder control.” She says.

“Oh, you mean Kegels!” I feel somewhat discouraged. “I’ve done those exercises–though not with any real consistency. You know, stopping the pee flow two to three times as you urinate.”

She shakes her head at this.

“Yeah. No. That’s the opposite of what we want you to do. Your bladder gets confused when you start and stop the stream. It has to tighten a band that you’ve just relaxed, so all you are doing is tiring out the muscles when what you need to do is relax them. You are also signaling the bladder to pee more frequently in small amounts. Which is the opposite of what you want.”

She describes a lot more about the process. I am not sure I can adequately relate everything here, so bear with me.

“First, you need to track when you are going–you can write it in a notebook or use an App to track where, when and how much you are going.”

“I…they have an APP for that?” I ask incredulously.

“Yep. I think it’s call something ‘you flow’ but any urine tracking app should work.”

Then she hands me some materials to read, saying, “These should help you to identify some common foods or drinks that exacerbate urinary incontinence.”

I scan the list.

“Caffeine, Chocolate, and SUGAR–even FAKE SUGAR? What’s left to live for?” I say this with a laugh, but honestly, I want to cry.

“This is to help you recognize things that may be making it harder for you to control your bladder. You don’t have to eliminate everything. As you keep track of your urination for the next few weeks, you can assess how the effects of multiple irritants may relate to your output and the frequency of your urges.”

I take my handouts, with muttered ‘thanks.’ It is daunting to imagine eliminating or minimizing favorites–the list of irritants is long–and includes spicy foods. The thought of never having Thai food again is just tragic. But the thought of getting up to pee all night long is also terrible to comprehend.

I go home. I do my best to follow her instructions. But my bladder isn’t the only thing confused.

The pattern of kegels done outside of just being in a bathroom is alien. Who sits and clenches their pelvic muscles throughout the day? But, I try.

I find it is hard to concentrate on doing it while standing. So, I decide to do it whenever I am engaged in a mostly mindless tasks and sitting down–like playing games on my phone or watching tv. It works, a bit. I’m on my phone most mornings as a wake up method and watch tv for at least an hour most nights.

But, it is weird. And hard to concentrate on doing two things at the same time. But sitting and just doing kegels is just as weird.

I have an appointment every week to learn new ways to improve my urinary challenges. I also report on the successes or failures.

“I Kegel, but I’m not sure it’s helping that much. Probably because it seems harder to do it after a while.” I admit.

“That’s because you are tiring those muscles out. Repetition will help increase the stamina.” She assures me.

What she tells me next, is less appealing than doing Kegels.

“Now that you know what triggers increased urination, we are going to try to train your bladder to wait longer between bathroom visits. When you get your first ‘signal’ that you need to pee, I want you to do a Kegel and hold it for about 10 seconds. And then relax the muscle and see whether the urge is still there. If it is repeat the Kegel until you no longer feel the urge to pee. We want you to teach it not to want to go so often–extend the length you can hold it by.” She says matter-of-factly.

“You mean, that by going to the bathroom at every opportunity I could, I taught my bladder that it couldn’t hold as much?” I’m flabbergasted, but not in a good way.

She is kind when she confirms my suspicions.

“Yes, in so many words. But the good thing is, we can retrain the bladder to a more normal schedule. We are going to help you–by strengthening your pelvic muscles with exercises; reducing your frequency during the day by stopping the urge using Kegels, for however long you can hold it off, and then, after that, we can work next on night training.”

“Night training?” I say with some small dread that I know what she’s going to say next.

“Yes. After you’ve been practicing during the day for a few weeks, we are going to put off going to the bathroom as frequently at night.”

“How?” I croak.

“Whenever you wake with the urge to pee and it isn’t time to get up, you’ll do Kegels to stop the first signal urge until you can fall back to sleep again. Do not get up and go to the bathroom until the urge is so overwhelming you can’t ignore it any more. It may take a few nights practice, possibly a week, but most women I’ve worked with see improvement within a few days.”

“And…what if I can’t hold it and I pee my bed?” I say, utterly picturing this exact thing happening.

“That’s why they invented Depends products. Wear them for protection–either at night or during the day when you think you may struggle to stay dry.”

Armed with information and a plan, I leave my therapist who assures me we will have a few appointments to check-in after I’ve tried the training.

It is awkward. For years, I became a blood hound for public bathrooms. I always needed to know where one was close by. I used any opportunity to pee, regardless of an actual need to go, thinking that emptying my bladder more often was the way to prevent accidents. But finding it is nearly the opposite of true was enlightening.

But, I did have accidents. A lot of them at first. Especially if I was working in my office for more than an hour, drinking tea, and then suppressed the urge to pee until it became more urgent. (Hey…root word of urgent is urge! How had I missed that before?) After the klaxon signaling my bladder would do any time I suppressed the first or second urge, I had to climb the stairs to my bathroom. That rarely turned out to be a good idea. For whatever reason, it is very hard to hold one’s water while lifting your legs and pulling your weight up over and over while clomping up flight of stairs.

I did a lot of laundry those first few weeks. I had accidents in public. And because I was too self-conscious to wear anything besides a pantyliner–I occasionally drove home in a puddle of my own making. But, with time, they were fewer and fewer. I even mastered the art of getting a plastic hat in place in the toilet and getting my pants down before wetting myself to measure the amount of urine and record it in my phone APP. I even succeeded with night training. (I only needed three nights–and three Depends lady panties to do it. )

It was the weirdest summer I’ve ever had. I’m glad I didn’t have to write a school report about What I did over summer vacation. Or, maybe I have written it here.

It took me years to realize I had a problem. The solution, while embarrassing to discuss with a doctor, was treatable. It hasn’t been perfect. I still love tea and that has it’s resultant effects on my bladder. As does Thai food. But, prepared for such exigencies one can always Depend on sanitary products to keep you dry if you absolutely must have Pad Thai.

So, don’t be too embarrassed to seek help. Ask your doctor about ‘Bladder Training.’ Be proud that you are looking for solutions instead of hiding and suffering in silence.

The internet is full of much better sources than my story. I found one here at UCSF Bladder Training. Enjoy!

_____________________________________________________________

(Final note: I wrote this blog post about a year ago. But, it wasn’t until now that I was brave enough to post this. I don’t want any woman or man with incontinence to live with the condition for as long as I did. Also, this isn’t a particularly funny post. So, I find those harder to write and feel they are ‘done.’ I hope you can agree, peeing against your will is never something to laugh at!)